title: Polysomnographic sleep aspects in liver cirrhosis: a case control study.
abstract: OBJECTIVE
  To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results.
  
  
  METHODS
  This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. The control group consisted of age- and gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classes of Child-Pugh classification in the cirrhotic group.
  
  
  RESULTS
  Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean ± SD: 73.89% ± 14.99% vs 84.43% ± 8.55%, P < 0.01), increased latency (151.27 ± 93.24 min vs 90.62 ± 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% ± 5.64% vs 20.71% ± 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 ± 2.85/h vs 2.79 ± 0.61/h, P < 0.01). The comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% ± 1.2%; Child B: 14.9% ± 1.2%; Child C: 8.6% ± 1.6%, P < 0.05).
  
  
  CONCLUSIONS
  Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters.
authors.affiliation: Department of Psychobiology, Federal University of São Paulo, São Paulo 04024-002, Brazil.
authors.forename: Vinicius Vasconcelos
authors.initials: VV
authors.lastname: Teodoro
authors.forename: Mauricio Augusto
authors.initials: MA
authors.lastname: Bragagnolo
authors.forename: Ligia Mendonça
authors.initials: LM
authors.lastname: Lucchesi
authors.forename: Daniel
authors.initials: D
authors.lastname: Cavignolli
authors.forename: Marco Túlio
authors.initials: MT
authors.lastname: de Mello
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Apnea-hypopnea index; Child-Pugh classification; Liver cirrhosis; Obstructive sleep apnea syndrome; Periodic limb movements in sleep; Polysomnography; Rapid eye movement sleep; Sleep